Portal vein thrombosis: What surgeons need to know

Abstract

Key points: (a) The lifetime risk of portal vein thrombosis (PVT) is approximately 1%; (b) The portal vein is formed by the union of the splenic and superior mesenteric veins posterior to the pancreas; (c) Imaging modalities most frequently used to diagnose PVT include sonography, computed tomography, and magnetic resonance imaging; (d) Malignancy, hepatic cirrhosis, surgical trauma, and hypercoagulable conditions are the most common risk factors for the development of PVT; (e) PVT eventually leads to the formation of numerous collateral vessels around the thrombosed portal vein; (f) First-line treatment for PVT is therapeutic anticoagulation-it helps prevent the progression of the thrombotic process; (g) Other therapeutic options include surgery and interventional radiographic procedures including mechanical thrombectomy and thrombolysis; (h) Portal biliopathy is a clinicopathologic entity characterized by biliary abnormalities due to portal hypertension secondary to PVT and appears to be more common in cases of extrahepatic PVT.

Republished with permission from: Quarrie R, Stawicki SP. Portal vein thrombosis: What surgeons need to know. OPUS 12 Scientist 2008;2(3):30-33.

Keywords: Complications; pathophysiology; portal vein thrombosis; risk factors; therapeutic interventions.

Figure 1

Examples of portal vein thrombosis as seen on computed tomographic imaging. Top left, widely patent main portal vein in a patient with hepatocellular carcinoma. Top right, same patient following hepatic trisegmentectomy procedure – note the poor visualization of the thrombosed portal vein. Bottom left, portal vein thrombosis following intraoperative portal venous injury. Bottom right, following operative thrombectomy, portal venous flow has been successfully re-established